Provider Demographics
NPI:1962448670
Name:OKTAVEC, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:OKTAVEC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 WHETSTONE PLACE
Mailing Address - Street 2:#106
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-826-3937
Mailing Address - Fax:904-826-3977
Practice Address - Street 1:100 WHETSTONE PLACE
Practice Address - Street 2:#106
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-826-3937
Practice Address - Fax:904-826-3977
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0046211207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D52804Medicare UPIN
FL15977XMedicare PIN